How Anaesthesiologists and Interns in Anaesthesia Care Describe and Categorise their Work Environment at a Swedish Hospital

The work environment for anaesthesiologist is characterised by high levels of stress, working under time pressure, delayed or cancelled breaks, frequent overtime, and high risk of emotional exhaustion. The aim of the study was to investigate how anaesthesiologists describe their work environment using a sample of anaesthesiologists and interns in anaesthesia care from a Swedish hospital. A web-based open-ended questionnaire was used to collect data on how anaesthesiologist describe and experience their work environment. A total of 129 free-text answers were collected and analysed. The results confirm previous findings of the strained work environment met by anaesthesiologists and their interns. However, the study also finds that positive relations between colleagues work as an important social and emotional support among the anaesthesiologists and their interns.

Work environment refers to factors that affect individuals in the work situation or in the workplace environment, i.e. biological, medical, physiological, psychological, social and technical factors. The legislation regarding occupational health and safety in Sweden aims to protect workers from poor working conditions. According to this legislation, employees are obligated to work with both psychological and physiological issues at their workplace [1], which means systematically assessing risks and taking actions to prevent hazards or negative issues, and to improve their work environment. Despite the legal requirements in place, studies indicate that there are workplaces that do not meet these requirements [2].

To evaluate and improve work environment issues in a systematic way, a structured support system was designed and implemented in municipalities and at a hospital in central Sweden [3-6]. The support model provides a structure and gives opportunity for continuous feedback through group reflections in the process of systematic work environment management, supporting both managers and their employees.

Work environment for anaesthesiologists have been described in recent international studies [7-10]. Specifically, it is characterised by high levels of stress, working under time pressure, delayed or cancelled breaks, frequent overtime, and high risk of emotional exhaustion. Anaesthesiologists working in perioperative settings are often responsible for several operating rooms and patients at the same time and are on-call when needed outside of the operating room [11]. In Sweden, the anaesthesiologist and the nurse anaesthetist work closely together. Between the cases in the operating room, anaesthesiologists also assess new patients who are scheduled for surgery ahead of time. Looking more specifically at anaesthesiologists in the operating theatre, they carry a heavy responsibility for patients’ lives during anaesthesia and surgery. Furthermore, anaesthesiologists have several workplaces at the hospital, namely operating theatres, the ICU departments, X-ray departments’ preoperative ward, management of acute and chronic pain in specific pain management wards, and the emergency department [11-13].

The aim of the study was to investigate how anaesthesiologists describe their work environment using a sample of anaesthesiologists from a Swedish hospital.

In this study, the anaesthesiologists and interns in anaesthesia care in the organisation were extracted from a larger hospital sample. The anaesthesiologists and interns worked in a perioperative department using a structured support model for systematic work environment management [3]. The perioperative organisation at the hospital had approximately 500 employees; moreover, it had gone through a re-organisation during 2018, just before the implementation of the model. The staff members comprised approximately 140 anaesthetist nurses, 90 operating room nurses, 40 anaesthesiologists, 20 interns in anaesthesia care, 230 nurses and assistant nurses from the postoperative ward, and managers from different levels in the organisation. Eligible respondents in this study were the group of anaesthesiologists and interns in anaesthesia care.

The participants answered an open-ended web-based questionnaire in the winter of 2018. Each participant was able to give up to seven free-text answers to the question: ‘How would you describe your current work situation?’ The respondents described their work environment in free-text and then categorised their answers according to pre-selected categories based on Wheelan’s keys to productive work teams [14]. Each free-text answer was grouped into one of the following categories: (1) Results and goal fulfilment, (2) External circumstances and the outside world, (3) Implementation and follow-up, (4) Work environment and health, (5) Roles and tasks, (6) Skills and learning, (7) Demands and feedback, (8) Time use and working methods, (9) Communication and collaboration, and (10) Other. Descriptive statistics was used to analyse the data (frequencies and proportions). The free-text answers were analysed using qualitative text analysis [15].

The study followed the Declaration of Helsinki regulations [16] (World Medical Association, 2013) and local ethical guidelines and regulations (Centre for Research Ethics and Bioethics). It was approved by the Swedish Ethical Review Authority (Dnr 2019-00948).

Answers from a total of 33 anaesthesiologists and interns in anaesthesia care (response rate: 55.0%) were collected using a web-based questionnaire for free-text answers. In total, 129 answers (mean = 3.9) were collected describing the work environment of the anaesthesiologists and interns in anaesthesia care at the hospital. Distribution of the answers is presented in table 1.

The focus was on the answers to the category Work environment and health (24.0% of the answers) and in the category Roles and tasks (26.4% of the answers). The category Skills and learning was also chosen to a certain extent (12.4% of the answers).

The anaesthesiologists and interns in anaesthesia care described their work environment in the category Work environment and health as stimulating and challenging work with good and highly competent colleagues. A typical comment among the free-text answers was: ‘[There is a] good collegiate climate right now between the working colleagues’.

On the negative side, the respondents described their work environment as stressful and intensive. They reported a feeling of low control of the workday (not being able to take lunch breaks or to go home by the end of the day as planned) and a feeling of not being able to perform all their duties because of being on call. Some of the participants complained about impaired sleep, and others mentioned stress and high workload: ‘During on-call time, you don't have time to do everything because new tasks appear. It is very labour intensive’.

Overall, the working climate and work environment were described in both positive and negative terms. One typical comment regarding the conditions faced by the participants was: ‘I think on-call work has become heavier in recent years. There is more to do at night, and you get less rest. There is an increased risk for the patients because you are not alert after working 17 hours straight’.

The findings confirm previous research on the strained work environment in the perioperative settings. According to previous studies, physicians are at risk of committing suicide because of heavy workload and long working hours, i.e. long shifts and unpredictable hours (associated with sleep deprivation), and stress due to the work situations (life and death emergencies) [17-19]. These kinds of factors are identified in the results of the present study when the anaesthesiologists and the interns in anaesthesia care described their work environment. A recent study shows that suicide rates among physicians in Europe is declining but still remains high among anaesthesiologists [19].

In previous studies, anaesthesiologists described the challenges of their work as heavy workload, especially during on-call hours, making them take on many responsibilities simultaneously [20]. These working conditions have been raised in several studies from different countries [8-10] and confirmed in the present study.

Shahla, et al. [21] claimed that anaesthesiologists reported fatigue, lack of collegiality or respect, and lack of training, as areas of job dissatisfaction, of which lack of respect was a contributor to burnout. The results of the present study confirm the feeling of fatigue and lack of good-quality sleep among anaesthesiologists. However, the findings also point to a positive climate among colleagues in the perioperative department. Such a positive and collegiate climate might “buffer” against stress and fatigue [22].

In summary, anaesthesia is a burdened workforce, and anaesthesiologists and their interns have multiple responsibilities, with the risk of being stressed or burned out and being affected by negative effects of their daily work. Good working conditions are important for their well-being, and it requires taking measures to evaluate burdensome issues in their work environment and taking actions to facilitate these. This study confirms previous findings of the strained work environment met by anaesthesiologists and their interns. However, the study also finds that positive relations between colleagues work as an important social and emotional support among the anaesthesiologists and their interns. A limitation of this study is that it was conducted at one specific site. A more comprehensive survey from several sites is needed to give a more general description of the work situation of anaesthesiologists and interns.

The participants are acknowledged for sharing their thoughts.

Ethical considerations

The study followed the Declaration of Helsinki regulations (World Medical Association, 2013) and local ethical guidelines and regulations (Centrum for Research Ethics and Bioethics, 2018). It was approved by the Swedish Ethical Review Authority (Dnr 2019-00948).

Conflict of interest

Magnus Svartengren (M.S.) has been Chairman of the Board of Directors for the Human Resources Institute AB, the organization that have owned the legal rights to the Human Resources Index measurement tool since 13 November 2020. However, this had no influence on the research design, analysis, and results. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Funding

FA Insurance (grant number: 160271) and the regional agreement on medical training and clinical research between Uppsala University and University Hospital (ALF), Uppsala, Sweden.

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